Provider Demographics
NPI:1710397617
Name:ICU EYE ASSOCIATES
Entity Type:Organization
Organization Name:ICU EYE ASSOCIATES
Other - Org Name:MIAMI SHORE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAMBROSIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:786-313-3048
Mailing Address - Street 1:9440 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2703
Mailing Address - Country:US
Mailing Address - Phone:786-313-3048
Mailing Address - Fax:786-313-3051
Practice Address - Street 1:9440 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2703
Practice Address - Country:US
Practice Address - Phone:786-313-3048
Practice Address - Fax:786-313-3051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3578152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty